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U.S. SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549
FORM 4
STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP
Filed pursuant to Section 16(a) of the Securities Exchange Act of 1934,
Section 17(a) of the Public Utility Holding Company Act of 1935 or
Section 30(f) of the Investment Company Act of 1940
[_] Check box if no longer subject of Section 16. Form 4 or Form 5 obligations
may continue. See Instruction 1(b).
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1. Name and Address of Reporting Person*
Bailey, Jr. Essel W.
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(Last) (First) (Middle)
900 Victors Way, Suite 345
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(Street)
Ann Arbor MI 48108
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(City) (State) (Zip)
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2. Issuer Name and Ticker or Trading Symbol
Omega Worldwide, Inc. (OWWI)
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3. IRS Identification Number of Reporting Person, if an Entity (Voluntary)
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4. Statement for Month/Year
January, 2000
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5. If Amendment, Date of Original (Month/Year)
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6. Relationship of Reporting Person to Issuer
(Check all applicable)
[x] Director [_] 10% Owner
[x] Officer (give title below) [ ] Other (specify below)
President, CEO and Chairman
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7. Individual or Joint/Group Filing (Check applicable line)
[x] Form filed by one Reporting Person [_] Form filed by more than one
Reporting Person
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<PAGE>
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Table I -- Non-Derivative Securities Acquired, Disposed of,
or Beneficially Owned
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<TABLE>
<CAPTION>
6.
4. 5. Owner-
Securities Acquired (A) or Amount of ship
3. Disposed of (D) Securities Form: 7.
Transaction (Instr. 3, 4 and 5) Beneficially Direct Nature of
2. Code ------------------------------- Owned at End (D) or Indirect
1. Transaction (Instr. 8) (A) of Month Indirect Beneficial
Title of Security Date ------------ Amount or Price (Instr. 3 (I) Ownership
(Instr. 3) (mm/dd/yy) Code V (D) and 4) (Instr.4) (Instr. 4)
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<S> <C> <C> <C> <C> <C> <C> <C> <C> <C>
Common Stock 1/28/2000 A* V 10,000 A $4.875 332,630 D
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520,804 I **
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*Common stock acquired represents 10,000 shares of restricted stock granted under the Company's Stock Option and Restricted Stock
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Plan which shares vest over an 18-month period with one-third vesting on July 28, 2000, one third vesting on January 28, 2001
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and one-third vesting on July 28, 2001.
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**Owned directly by Menakka Bailey; Essel W. Bailey, Jr. disclaims beneficial ownership in said shares.
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NOTE: Essel W. Bailey, Jr. is a trustee of the Montague Foundation. The foundation holds 5,613 shares of Omega Worldwide, Inc.
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common stock. Mr. Bailey disclaims any beneficial ownership in those shares (Rule 16a - 1(a)(2)).
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</TABLE>
* If the Form is filed by more than one Reporting Person, see Instruction
4(b)(v).
Reminder: Report on a separate line for each class of securities beneficially
owned directly or indirectly.
(Print or Type Responses)
(Over)
(Form 4-07/98)
<PAGE>
FORM 4 (continued)
Table II -- Derivative Securities Acquired, Disposed of, or Beneficially
Owned (e.g., puts, calls, warrants, options, convertible securities)
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<TABLE>
<CAPTION>
10.
9. Owner-
Number ship
of Form
2. Deriv- of
Conver- 5. 7. ative Deriv- 11.
sion Number of Title and Amount Secur- ative Nature
or Derivative 6. of Underlying 8. ities Secur- of
Exer- 4. Securities Date Securities Price Bene- ity: In-
cise 3. Trans- Acquired (A) Exercisable and (Instr. 3 and 4) of ficially Direct direct
Price Trans- action or Disposed Expiration Date ---------------- Deriv- Owned (D) or Bene-
1. of action Code of(D) (Month/Day/Year) Amount ative at End In- ficial
Title of Deriv- Date (Instr. (Instr. 3, ---------------- or Secur- of direct Owner-
Derivative ative (Month/ 8) 4 and 5) Date Expira- Number ity Month (I) ship
Security Secur- Day/ ------ ------------ Exer- tion of (Instr. (Instr. (Instr. (Instr.
(Instr. 3) ity Year) Code V (A) (D) cisable Date Title Shares 5) 4) 4) 4)
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<S> <C> <C> <C> <C> <C> <C> <C> <C> <C> <C> <C> <C> <C> <C>
Options (right
to buy) $4.875 01/28/2000 A* V 50,000 * * Common 50,000 188,000 D
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</TABLE>
Explanation of Responses:
*On January 28, 2000, 50,000 incentive stock options were granted to the
undersigned. Options are exercisable as to one-third of the shares after
January 28, 2001, as to an additional one-third after January 28, 2002, and as
to the balance after January 28, 2003, all at an exercise price of
$4.875. Incentive stock options expire ten years after granted.
/s/ Essel W. Bailey, Jr.
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**Signature of Reporting Person Date
** Intentional misstatements or omissions of facts constitute Federal
Criminal Violations.
See 18 U.S.C. 1001 and 15 U.S.C. 78ff(a).
Note: File three copies of this Form, one of which must be manually signed.
If space provided is insufficient, see Instruction 6 for procedure.
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